title: Food avoidance in children with adverse food reactions: influence of anxiety and clinical parameters.
abstract: BACKGROUND
  Many children in the general population avoid food because of self-reported adverse food reactions (AFR). Food avoidance can have negative consequences for well-being and nutritional status. This study aimed to investigate which factors are related to avoidance behavior in children (10-13 yr old) from the general population.
  
  
  METHODS
  Questionnaires for both mother and child were sent to participants from the Europrevall study: 164 children with self-reported AFR and 170 children without AFRs. Spielberger state anxiety and trait anxiety and clinical parameters, such as severity of the adverse reaction, specific IgE and doctor's diagnosis, were compared between those who have (had) AFR and avoid food (i.e., avoiders) and those who have (had) AFR(s) and do not avoid food (anymore; i.e., non-avoiders).
  
  
  RESULTS
  In total, 59% of the children with AFRs avoided food, of whom 26% had positive specific immunoglobulin E (sIgE). Child's state anxiety about an AFR was higher in avoiders than in non-avoiders, (p < 0.001), whereas child's trait anxiety and maternal state anxiety and trait anxiety were comparable in both groups. Avoiders reported more often severe symptoms (i.e., generalized urticaria, respiratory or cardiovascular symptoms) than non-avoiders, (p = 0.03). Food avoidance was not associated with doctor's diagnosis of food allergy or doctor's advice to avoid food (p = 1.00).
  
  
  CONCLUSIONS
  Food avoidance is related to child's state anxiety about an adverse food reaction. Food avoidance seems to be independent of a doctor's diagnosis of food allergy and advice on food avoidance.
authors.affiliation: Department of Dermatology & Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Thuy-My
authors.initials: TM
authors.lastname: Le
authors.forename: Wieneke T
authors.initials: WT
authors.lastname: Zijlstra
authors.forename: Eveline Y
authors.initials: EY
authors.lastname: van Opstal
authors.forename: Mirjam J
authors.initials: MJ
authors.lastname: Knol
authors.forename: Monique P
authors.initials: MP
authors.lastname: L'Hoir
authors.forename: André C
authors.initials: AC
authors.lastname: Knulst
authors.forename: Suzanne G M A
authors.initials: SG
authors.lastname: Pasmans
mesh_terms: D000293:Adolescent; D000485:Allergens / Q000009:adverse effects / Q000276:immunology; D001007:Anxiety; D002648:Child; D005247:Feeding Behavior; D005260:Female; D005502:Food / Q000009:adverse effects; D005512:Food Hypersensitivity / Q000175:diagnosis / Q000523:psychology*; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D009035:Mothers; D057566:Self Report; D011795:Surveys and Questionnaires
chemical_list: D000485:Allergens; D007073:Immunoglobulin E
keywords: children; food allergy; food avoidance; state anxiety; trait anxiety